The objective of the PHIS+ project is to build on the existing infrastructure provided by Child Health Corporation of America (CHCA)--a business alliance networking 42 of North America's leading children's hospitals--to augment its existing database with laboratory and radiology data for children seen in the ambulatory and inpatient departments of 6 large children's hospitals. The existing database, called the Pediatric Health Information System (PHIS), is a comprehensive pediatric database containing clinical and financial details of more than six million patient cases. The enhanced database, called PHIS+, will provide a rich data source for academic clinicians to answer in real time the comparative effectiveness questions that affect hospitalized children, thereby significantly enhancing the quality and scope of pediatric comparative effectiveness research. The specific aims are: 1. To develop the infrastructure for accurately and reliably performing quarterly downloads of laboratory results and radiology reports from 6 CHCA-member children's hospitals into the existing Pediatric Health Information System (PHIS). 2. To demonstrate the utility of the PHIS+ database in the performance of multiple comparative effectiveness research studies The hospitals collaborating on this proposal are national leaders in the use of electronic medical records and will provide highly accurate and complete clinical data collected as a routine part of clinical care. The outlined proposal will build the data platform needed to make advances in the following 4 areas: (1) Make the most efficient use of our diagnostic armamentarium (i.e. laboratory testing and imaging studies) to predict outcomes, select appropriate interventions, and improve the health status of hospitalized children; (2) Apply state-of-the- art observational study design and analysis to existing data in administrative and clinical databases in to evaluate therapeutic, prognostic, and diagnostic strategies for conditions for which randomized controlled trials are not feasible; (3) Perform economic evaluations of inpatient management strategies to inform resource allocation and, coupled with outcomes measurement, better understand value; and (4) Develop quality measures and severity adjustment tools to study inpatient quality (comparing hospitals, providers, systems) across multiple institutions using large administrative and clinical databases. The PHIS+ project will use an existing robust computational infrastructure-The Federated Utah Research and Translation Health electronic Repository (FURTHeR)-to link data from 6 children's hospitals (with the potential to expand to more) and sites of care (inpatient, outpatient, Emergency Department, Day Surgery) and conduct meaningful comparative effectiveness research in several AHRQ priority areas for several AHRQ priority populations, including children, children with multiple co-morbidities, minorities, and those from lower socioeconomic status. PUBLIC HEALTH RELEVANCE: The construction of the PHIS+ database proposed in this application will provide academic clinicians with a rich data source to study large proportions of the pediatric population and answer in real time the comparative effectiveness questions that affect hospitalized children. With this enhanced database, researchers will be able to predict outcomes, evaluate treatment strategies, select appropriate interventions, evaluate cost effectiveness, and measure quality of care. The research conducted with the PHIS+ database will improve the health status of hospitalized children including those in AHRQ identified priority populations such as minorities, those with multiple co-morbidities, and those from lower socioeconomic status.